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Complications of Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.

ABSTRACT: OBJECTIVE:To compare the risks of complications of primary total hip arthroplasty (THA) between patients with ankylosing spondylitis (AS) and those without AS. METHODS:In this population-based study, we examined data from 1999 to 2013 of US Medicare beneficiaries (ages <75 years old) with AS and a comparison group without AS who had undergone primary THA. Complications were based on the Centers for Medicare & Medicaid Services 2013 THA Complication Measure, which included myocardial infarction, pneumonia, or sepsis within 7 days; surgical site bleeding, pulmonary embolus, or venous thrombosis within 30 days; or mechanical complications or local infection within 90 days. Mortality within 90 days, revision arthroplasty within 1 year, long length of stay, discharge to a care facility, and readmission within 90 days were also examined. RESULTS:The study included 2,773 patients with AS and 107,341 patients without AS who had THA. Perioperative complications, 30-day complications, and local infections were rare in both groups (<1%). Mechanical complications and revision arthroplasty were uncommon in both groups. Ninety-day mortality was lower among patients with AS than those without AS (0.36% versus 0.7%). Patients with AS were more likely to be discharged to a care facility, and slightly more likely to have a long length of stay. Likelihood of a long stay was lower at hospitals that performed ?100 THAs per year, but other complications were not associated with hospital volume. CONCLUSION:Complications after primary THA are uncommon in patients with AS and similar in frequency to those without AS. Ninety-day mortality was lower among patients with AS.

SUBMITTER: Ward MM

PROVIDER: S-EPMC6193863 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Complications of Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.

Ward Michael M MM

Arthritis care & research 20181215 8

<h4>Objective</h4>To compare the risks of complications of primary total hip arthroplasty (THA) between patients with ankylosing spondylitis (AS) and those without AS.<h4>Methods</h4>In this population-based study, we examined data from 1999 to 2013 of US Medicare beneficiaries (ages <75 years old) with AS and a comparison group without AS who had undergone primary THA. Complications were based on the Centers for Medicare & Medicaid Services 2013 THA Complication Measure, which included myocardi ...[more]

PMID: 29669197

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Project description:IntroductionThe outcome following major arthroplasty surgeries in patients with ankylosing spondylitis (AS) has tremendously improved over the past decades, due to substantial amelioration in the medical therapies and sophistication of available surgical modalities. Although various studies have already demonstrated the complication rates and challenges faced in AS patients undergoing THA, there is a substantial paucity of data on the actual healthcare burden associated with this disease, and the diverse factors which may affect it.MethodsUsing the National Inpatient Sample (NIS) database (on the basis of ICD-10 CMP codes), patients undergoing THA between the years 2016 and 2019 were identified. These patients were then classified into two categories: group A: patients with a known diagnosis of AS; and group N: those without. The details regarding demographical information, associated co-morbidities, data pertaining to patients' hospital admissions including expenditure incurred, length of stay and complications encountered, were compared. In addition, propensity-score matching was performed to identify a 1:1 matched sample of THA patients without AS.ResultsOverall, 367,890 patients underwent THA; among whom, 501 (0.14%) were known AS patients (group A). Group A included a substantially higher proportion of patients belonging to younger age group (58.6 ± 13.4 versus 65.9 ± 11.4 years; p < 0.001), male sex (67.1% in group A vs 44.1% in group N; p < 0.001), and Asian ethnicity (p < 0.001). Group A patients had a substantially higher risk for longer duration of hospital stay (p < 0.03) and higher overall healthcare expenditure incurred (p < 0.001). As compared to group N, AS patients had a significantly higher risk for developing post-operative anemia [21.8% (group A) vs 11.8% (group N); p < 0.02]; and higher rate of periprosthetic infections [2.4% (group A) vs 1.0% (group N); p < 0.007].ConclusionPatients with AS require a significantly longer duration of hospital stay and higher admission-related expenditure following THA, as compared to the general population. These enhanced early health care-associated costs can be attributed to higher complication rates in AS patients. AS patients are prone to higher rates of anemia and peri-prosthetic infections during the early post-THA period.

Project description:Importance:Controversy exists about the preferred surgical approach for total hip arthroplasty (THA). Objective:To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. Design, Setting, and Participants:Population-based retrospective cohort study of all adults in Ontario, Canada, who had undergone primary THA for osteoarthritis between April 1, 2015, and March 31, 2018. All patients were followed up over a 1-year period (study end date, March 31, 2019). Exposures:Surgical approach (anterior vs lateral/posterior) for THA. Main Outcomes and Measures:Major surgical complications within 1 year (composite of deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Outcomes were compared among propensity-score matched groups using Cox proportional hazards regression. Results:Of the 30 098 patients (mean [SD] age, 67 years [10.7 years]; 16 079 women [53.4%]) who underwent THA, 2995 (10%) underwent the anterior approach; 21 248 (70%), the lateral approach; and 5855 (20%) the posterior approach performed at 1 of 73 hospitals by 1 of 298 surgeons. All patients were followed up for 1 year. Compared with those undergoing the lateral or posterior approach, patients undergoing an anterior approach were younger (mean age, 65 vs 67 years; standardized difference, 0.17); had lower rates of morbid obesity (4.8% vs 7.6%; standardized difference, 0.12), diabetes (14.2% vs 19.9%; standardized difference, 0.15), and hypertension (53.4% vs 62.9%; standardized difference, 0.19); and were treated by higher-volume surgeons (median range, 111 procedures; interquartile range, 69-172 vs 77 procedures, interquartile range, 50-119 in the prior year; standardized difference, 0.55). Compared with 2993 propensity-score matched patients undergoing a lateral or posterior approach, the 2993 matched patients undergoing anterior approaches had a significantly greater risk of a major surgical complication (61 patients [2%] vs 29 patients [1%]; absolute risk difference, 1.07%; 95% CI, 0.46%-1.69%; hazard ratio, 2.07; 95% CI, 1.48 to 2.88). Conclusions and Relevance:Among patients undergoing total hip arthroplasty, an anterior surgical approach compared with a posterior or lateral surgical approach was associated with a small but statistically significant increased risk of major surgical complications. The findings may help inform decisions about surgical approach for hip arthroplasty, although further research is needed to understand pain and functional outcomes.

Dataset Information

Complications of Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.

Publications

Complications of Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.

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